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INSURANCE VERIFICATION FORM

We Accept Most Insurance Plans

At Evident Alternatives, we strive to make our services accessible to individuals with various insurance coverage. We accept a wide range of major insurance plans to ensure that our patients can receive the benefits of our innovative pain management treatments.

Welcome! Getting started with our telehealth services is quick and straightforward. Simply fill in the fields provided on this form, and you'll receive a call from one of our providers. Alternatively, feel free to give us a call today for immediate assistance!

We will verify your insurance and follow up with coverage benefits.

Patient Information

Date of Birth
Month
Day
Year

Pain Problem:

Primary Insurance

Secondary Insurance


Evident Alternatives

Address

Evident Alternatives, LLC

119 West Petty Lane

Winchester TN.

Email

reviveneurohealth@gmail.com

931-307-9706

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Opening Hours:

Mon - Fri:  by app

​​Saturday: by appointment ​

Sunday: Closed

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